Provider Demographics
NPI:1639155930
Name:CROSS, CARROLL E (MD)
Entity Type:Individual
Prefix:DR
First Name:CARROLL
Middle Name:E
Last Name:CROSS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:STE 3400, DIVISION OF PULMONARY AND CRITICAL CARE MED
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-3564
Mailing Address - Fax:916-734-7924
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:STE 3400, DIVISION OF PULMONARY AND CRITICAL CARE MED
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-3564
Practice Address - Fax:916-734-7924
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA205200207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA205200Medicaid
CAA205200Medicare ID - Type Unspecified
CAA205200Medicaid